Prognostic factors of knee pain and function 12 months after total knee arthroplasty: A prospective cohort study of 798 patients.

BACKGROUND: Approximately 20% of patients undergoing total knee arthroplasty (TKA) do not experience long-term improvements. Our aim was to identify prognostic factors of knee pain and function 12 months after TKA. METHODS: In a prospective cohort study, 1026 patients underwent primary TKA between 2018 and 2020. Main outcome was measured by the Oxford Knee Score (OKS) categorized in five categories (0-9, 10-19, 20-29, 30-39 and 40-48). Potential prognostic factors obtained at baseline included sex, age, baseline OKS, pain catastrophizing scale, EuroQol 5 dimensions, previous surgery, BMI, ASA classification, opioid consumption, living and employment conditions as well as educational level. Ordinal logistic regression analysis was used to identify prognostic factors of OKS. RESULTS: A total of 915 patients completed follow up (89%), and patients with complete data were included (n = 798). Patients with a baseline OKS between 10-19 and 20-29 had 2.5 (CI 1.6;4.0) and 1.6 (CI 1.1;2.4) higher odds, respectively, of no improvement or deterioration to a lower post-operative OKS category, compared with patients with a baseline score between 30 and 39. Female patients had 1.5 (CI 1.1;2.0) and patients receiving social benefits compared with retired patients had 2.0 (CI 1.1;3.5) higher odds of no improvement or deterioration to a lower OKS category. CONCLUSION: Baseline level of pain and function, sex and employment status were significant prognostic factors of OKS 12 months after TKA. Overall, the regression analysis only explained 4% of the outcome, indicating that it is difficult to predict 12-month TKA outcome prior to surgery.

Disability and physical activity in people with chronic disease receiving physiotherapy. A prospective cohort study.

Chronic disease affects patients' disability and participation in activities of daily living. Longitudinal information on disability and physical activity is generally scarce in patients with chronic disease. The current study aimed to investigate if self-reported disability and physical activity changed in patients with chronic disease receiving physiotherapy. Furthermore, the aim was to assess if an improvement in self-reported disability was related to an increase in objectively measured physical activity and if an aggravation in self-reported disability was related to a decrease in physical activity. Seventy patients with either multiple sclerosis, Parkinson's disease, rheumatoid arthritis or stroke receiving free of charge physiotherapy were tested at baseline and 1 year later. Disability was measured with the self-reported modified Ranking Scale-9 Questionnaire and physical activity was objectively measured using tri-axial accelerometry. Neither self-reported disability nor physical activity changed among patients receiving 1 year of free of charge physiotherapy at group level. Furthermore, self-reported change of disability was not expressed with changes in objectively measured physical activity, indicating that the two measures represent two different constructs.

Analysis of 15 different pelvis marker protocols during sit-to-stand.

Sit-to-stand (STS) is a common transition movement needed to perform daily tasks. Previously, the kinematics of the STS movement has been investigated using optical motion capture. This method uses cameras and reflective markers on the body to capture movements. During STS, these markers can be difficult to measure due to blocked vision from the chair's arm- and backrest. This can result in poor data quality. The aim of this study was to investigate 15 different marker protocols and compare them in terms of visibility and selected outcome measures: hip flexion mean angle and range of motion (ROM). Fourteen healthy subjects completed five successful trials of STS. Marker protocols consisted of three anterior marker protocols and five posterior marker protocols, combined into a total of 15 marker protocols. For visibility, the traditional pelvis marker protocol proved unsuitable for STS tracking. Marker pins or additional markers anteriorly, and sacrum markers posteriorly, proved to be more suitable alternatives. For hip flexion mean angle and ROM, the estimates had similar tendencies. Hence, marker protocols were not outcome measure specific. Anteriorly, marker pins resulted in similar estimates as the traditional pelvis marker protocol. Posteriorly, sacrum markers estimated a smaller hip flexion angle, compared to the traditional pelvis marker protocol. In conclusion, marker pins can be used instead of regular ASIS markers at anterior pelvis. Posteriorly, sacrum markers can be used instead of PSIS markers.

Global Research Alliance N2 O chamber methodology guidelines: Flux calculations.

A critical step in determining soil-to-atmosphere nitrous oxide (N2 O) exchange using non-steady-state chambers is converting collected gas concentration versus time data to flux values using a flux calculation (FC) scheme. It is well documented that different FC schemes can produce different flux estimates for a given set of data. Available schemes differ in their theoretical basis, computational requirements, and performance in terms of both accuracy and precision. Nonlinear schemes tend to increase accuracy compared with linear regression but can also decrease precision. The chamber bias correction method can be used if soil physical data are available, but this introduces additional sources of error. Here, the essential theoretical and practical aspects of the most commonly used FC schemes are described as a basis for their selection and use. A gold standard approach for application and selection of FC schemes is presented, as well as alternative approaches based on availability of soil physical property data and intensity of sample collection during each chamber deployment. Additional criteria for scheme selection are provided in the form of an error analysis tool that quantifies performance with respect to both accuracy and precision based on chamber dimensions and sampling duration, soil properties, and analytical measurement precision. Example error analyses are presented for hypothetical conditions illustrating how such analysis can be used to guide FC scheme selection, estimate bias, and inform design of chambers and sampling regimes.

Three-dimensional kinematics of shoulder function in stroke patients: Inter- and intra-rater reliability.

BACKGROUND: It is important to monitor progress during rehabilitation of stroke patients. To that end, clinical function tests may be supported by three-dimensional kinematic measures. The aim of this study was to evaluate the inter- and intra-rater reliability of three-dimensional kinematic measures of shoulder movements in stroke patients with reduced shoulder function. METHODS: Seventeen patients were tested in three sessions by two trained raters. Three-dimensional motion capture was performed of the more affected upper extremity and the trunk. Measures of movements of the scapula and humerus related to the trunk, the trunk related to the laboratory, the forearm related to the humerus, and temporospatial measures were obtained during two reach tasks from the Wolf Motor Function Test, ReachLow and ReachHigh. Inter- and intra-rater reliability was quantified with intraclass correlation coefficients (ICC). FINDINGS: In general, range of movements of scapula, shoulder, trunk and elbow and movement time and reach length showed high inter-rater reliability (ICC∞ 0.84-0.98) and intra-rater reliability (ICC∞ 0.75-1.00), A minimum of five trials per task were required to achieve reliable ICC estimates. INTERPRETATION: Selected three-dimensional kinematic measures can be used reliably to evaluate specific movements of the shoulder in stroke patients with reduced shoulder function.

Reducing redundant testing using the Functional Independence Measure and Early Functional Abilities scale during rehabilitation in patients with brain injury.

PRIMARY OBJECTIVE: Rehabilitation scales following neurological injury can be useful for monitoring patient progress. However, too often, rehabilitation scales are administered unnecessarily placing an extra burden on clinicians and patients. The primary objective was to reduce redundant testing by providing guidelines for the concurrent use of the Functional Independence Measure (FIM) and Early Functional Abilities (EFA) scales during rehabilitation in patients with brain injury. METHODOLOGY: In total, 3289 concurrent FIM and EFA scores from 929 patients were examined. We proposed, using clinically sound and operational criterion, that the FIM should be used throughout rehabilitation, EFA should be used as a supplement when the FIM is ≤36 and FIM should be administered before the EFA on each testing occasion. RESULTS: Around 24% of patients should be measured with the FIM and EFA throughout rehabilitation, 35% of patients should be measured with the EFA and FIM initially but not require EFA measurements when there is an increase in function and 39% of patients should only be measured with the FIM. According to these guidelines, the EFA was administered unnecessarily 53% of the time. CONCLUSIONS AND IMPLICATIONS: These guidelines ensure that the EFA is used when it is sensitive. This will optimize clinician time and minimize redundant testing, without compromising the measurement of clinical progress.

Posterior or anterolateral approach in hip joint arthroplasty - Impact on frontal plane moment.

BACKGROUND: Anterolateral surgical approach in hip joint arthroplasty necessitates division of the hip abductor muscle complex, which may compromise postoperative gait observed in the frontal plane. The aim of the study was to compare frontal plane moment after hip joint arthroplasty by anterolateral or posterior approach and to explore which compensatory strategies patients use to decrease frontal plane moment. METHODS: Twenty-eight patients were randomized by sealed envelopes to hip resurfacing arthroplasty surgery by anterolateral (ad modum Watson) or posterior (ad modum Moore) approach, performed by two senior surgeons. Gait analyses were performed using 3D motion capture before surgery, 3, and 12 months after surgery. Peak ground reaction force was extracted for early and late stance and the corresponding frontal plane moment was defined. Measures of lateral trunk inclination, pelvic drop and hip abduction were obtained for the stance phase of the affected leg. FINDINGS: An effect of surgical approach on frontal plane moment for the affected leg was found during early stance phase (p = 0.006) where average frontal plane moment in the anterolateral groups was 202.42 N mm/kg in less compared to the posterior group after one year. A similar effect from baseline to 12 months for trunk inclination (p = 0.03) and an overall negative correlation between frontal plane moment and trunk inclination was found (r = -0.66, p = 0.03). INTERPRETATION: Frontal plane moment during early stance was less one year after hip joint arthroplasty through anterolateral compared to posterior approach. Patients' primary strategy to reduce frontal plane moment seems to be increased lateral trunk inclination.

Referral decision support in patients with subacute brain injury: evaluation of the Rehabilitation Complexity Scale - Extended.

PURPOSE: To test if the Rehabilitation Complexity Scale Extended (RCS-E) can be used as decision support for patient referral to primary rehabilitation as either complex specialized services (CSS) or district specialist services (DSS). METHOD: Two independent expert teams analyzed medical records on 299 consecutive patients admitted for CSS or DSS rehabilitation. One team provided a golden standard for the patient referrals, and the other team provided RCS-E scores. Models for predicting referrals from RCS-E scores were developed on data for 149 patients and tested on the remaining 150 patients. RESULTS: The optimal RCS-E sum score threshold for referral prediction was 11, predicting the golden standard for patient referral with sensitivity 88%, specificity 78% and correct classification rate 81%. Improved referral prediction performance was achieved by using RCS-E item-wise score thresholds (sensitivity 81%, specificity 89%, correct classification rate 87%). The RCS-E sum score range for patients referred CSS and DSS by the item-wise model was, respectively, 0-12 and 2-22 suggesting strong non-linear interaction of the RCS-E items. CONCLUSIONS: We found excellent referral decision support in the RCS-E and the item specific threshold model, when patients with acquired brain injury are to be referred to CSS or DSS as their primary rehabilitation. Implications for Rehabilitation Efficient rehabilitation after acquired brain injury requires rehabilitation settings that meet patient needs. Validated tools for referral decision support make the process more transparent. Patient rehabilitation complexity can be stratified by the RCS-E with high sensitivity, specificity and predictive value of positive test. RCS-E is an excellent tool for referral decision support.

Assessment of primary rehabilitation needs in neurological rehabilitation: translation, adaptation and face validity of the Danish version of Rehabilitation Complexity Scale-Extended.

BACKGROUND: Assessing primary rehabilitation needs in patients with acquired brain injury is a challenge due to case complexity and the heterogeneity of symptoms after brain injury. The Rehabilitation Complexity Scale-Extended (RCS-E) is an instrument used in assessment of rehabilitation complexity in patients with severe brain injury. The aim of the present study was to translate and test the face validity of the RCS-E as a referral tool for primary rehabilitation. Face validity was tested in a sample of patients with acquired brain injury. METHODS: Ten clinicians and records from 299 patients with acquired brain injury were used in the translation, cross-cultural adaptation and face validation study of the RCS-E. RCS-E was translated into Danish by a standardized forward-backward translation by experts in the field. Face validity was assessed by a multi-professional team assessing 299 patients. The team was asked their opinion on whether the RCS-E presents a sufficient description of the patients. RESULTS: The RCS-E was translated according to international guidelines and tested by health professionals; some adaptations were required due to linguistic problems and differences in the national health system structures. The patients in the study had a mean age of 63.9 years (SD 14.7); 61 % were male. We found an excellent face validity with a mean score of 8.2 (SD 0.34) assessed on a 0-10 scale. CONCLUSIONS: The RCS-E demonstrated to be a valid assessment of primary rehabilitation needs in patients with acquired brain injury. Excellent face validity indicates that the RCS-E is feasible for assessing primary rehabilitation needs and the present study suggests its applicability to the Danish health care system.

Skeletal muscle fiber characteristics and oxidative capacity in hemiparetic stroke survivors.

INTRODUCTION: Skeletal muscle is changed after stroke, but conflicting data exist concerning muscle morphology and oxidative enzyme capacity. METHODS: In 36 chronic stroke patients bilateral rectus femoris muscle biopsies were analyzed, and fiber type proportions and cross-sectional areas were determined by ATPase histochemistry. Enzymatic concentrations of citrate synthase (CS) and 3-Hydroxyacyl-coenzymeA-dehydrogenase (HAD) were determined using freeze-dried muscle tissue. Findings were correlated with clinical outcomes. RESULTS: In the paretic muscles the mean fiber area was smaller (P = 0.0004), and a lower proportion of type 1 fibers (P = 0.0016) and a higher proportion of type 2X fibers (P = 0.0002) were observed. The paretic muscle had lower CS (P = 0.013) and HAD concentrations (P = 0.037). Mean fiber area correlated with muscle strength (r = 0.43; P = 0.041), and CS concentration correlated with aerobic capacity (r = 0.47; P = 0.01). CONCLUSIONS: In stroke survivors there is a phenotypic shift toward more fatigable muscle fibers with reduced oxidative enzymatic capacity that relates to clinical outcomes.

The effect of age on rehabilitation outcome after traumatic brain injury assessed by the Functional Independence Measure (FIM).

BACKGROUND: The impact of age on rehabilitation outcome after traumatic brain injury (TBI) as measured by changes in the Functional Independence Measure (FIM) has been addressed in several seemingly conflicting reports. Differences may be explained by different study populations and different ways of analyzing data. OBJECTIVE: To investigate the role of data analysis in the interpretation of the age effect on rehabilitation outcome after TBI by comparing classical analyses of the total FIM score with a new item-wise analysis that unfolds the comprehensive amount of information contained in the FIM measurement otherwise concealed by the total score. METHODS: We analyzed admission and discharge FIM data from 411 consecutive TBI patients admitted to inpatient rehabilitation during 1998-2011 by both methods. RESULTS: The classical analysis indicated similar rehabilitation outcome in the 18 to 39, 40 to 64, and 65+ years age groups, which could be explained by selection of strong elderly patients and/or methodological problems with classical data analyses, whereas the item-wise analysis demonstrated profound age effect on most FIM items throughout the age interval covered. CONCLUSIONS: The item-wise analysis meets requirements of proper data analysis, avoids concealing diversity in rehabilitation outcome behind the total FIM score, and provides a flexible, informative, and clinically relevant data analysis.

Using EFA and FIM rating scales could provide a more complete assessment of patients with acquired brain injury.

PURPOSE: In some hospitals, patients exhibit significant heterogeneity of function at admission and discharge. The current study aims to assess if concurrent usage of the Early Functional Assessment (EFA) and Functional Independence Measure (FIM) is warranted and practical in rehabilitation centers with diverse patient groups and outcomes. METHODS: This retrospective study examined a data set of all patients with concurrent EFA and FIM scores admitted to a single rehabilitation center (4076 scores from 1251 patients). The patients had acquired brain injury of multiple etiologies and a range of severities. RESULTS: The EFA scale was more able to characterize the function of lower functioning patients according to the FIM while the FIM scale was more able to characterize the function of higher functioning patients according to the EFA. This was highlighted by 21% of assessments with the lowest FIM score (18) having corresponding EFA scores of 22-76 and 27% of assessments with the highest EFA score (>90) having corresponding FIM scores of 38-126. CONCLUSIONS: In rehabilitation centers with diverse patient groups and outcomes, the FIM and EFA scale could be used to characterize the heterogeneity of function in patients with acquired brain injury. The EFA/FIM scale could be used concurrently in certain patients providing a more complete view of patients throughout the rehabilitation process.

Effects of resistance training and aerobic training on ambulation in chronic stroke.

OBJECTIVE: The aim of this study was to directly compare the effects of aerobic training (AT) with progressive resistance training (RT) after stroke to determine whether AT-induced fitness gains or RT-induced strength gains translate into improved ambulation across a 12-wk intervention and whether gains are retained 1 yr after cessation of formal training. DESIGN: This study is a randomized controlled 12-wk intervention trial with a 1-yr follow-up. Forty-three community-dwelling independent walkers with a chronic ischemic hemiparetic stroke were allocated to AT using a cycle ergometer (n = 13), RT using training machines (n = 14), or low-intensity sham training of the arms (n = 16). The main outcome measures were 6-min walk distance and fast 10-m walking speed. RESULTS: Comparisons between AT, RT, and sham training revealed no clinically relevant effects on walking velocity or walking distance. Muscle strength improved after RT (P < 0.0001) and was preserved at 1-yr follow-up (P < 0.001). Aerobic capacity increased after AT (P < 0.001) but was lost during the follow-up observation period. CONCLUSIONS: Improvement of muscle strength or aerobic capacity using non-task-specific training methods does not result in improved ambulation in patients with chronic stroke. Muscle strength gains were maintained at follow-up, whereas all improvements of aerobic capacity were lost, indicating a long-lasting effect of intensive RT even without maintenance training.

Standard assumptions about the trial-by-trial distribution of averaged electromyography data could produce erroneous results.

The aim was to challenge the assumptions of standard statistical analyses of average surface electromyography (sEMG) data as a measurement of response magnitudes following the generation of a reflex. The ipsilateral tibial nerve was stimulated at three stimulation intensities and the response sEMG was measured in the contralateral soleus (cSOL) muscle. The magnitude of the cSOL response was measured at a set time window following ipsilateral tibial nerve stimulation. The averaged and trial-by-trial response magnitudes were assessed and compared. The analysis of the averaged and trial-by-trial response revealed significantly different results as the trial-by trial response magnitudes were log-normally distributed with between subject variance heterogeneity violating assumptions of standard statistical analyses. A statistical model has been suggested for the analysis of the responses. By ignoring trial-by-trial response variability and distribution, erroneous results may occur. This may change the interpretation of the results in some studies.